Posttraumatic carotid -cavernous fistula following orbitocranial penetrating injury: case report and literature review

Abstract

Objective To explore the diagnosis and treatment strategies of carotid- cavernous fistula (CCF) following orbito - cranial penetrating injury with cases report and literature review.Method We report a case of occult post - traumatic CCF in a 19 - year - old male who was stabbed by a 12 cm long wooden foreign body from left orbit into the contralateral cavernous sinus region.Original cerebral angiography demonstrated no CCF.But after a tentative lightly move of foreign body,right occult post - traumatic CCF was found.With adequate preoperative preparation,foreign body was extracted completely and CCF was managed with endovascular embolization within no more than one minute.Results After embolization treatment,CCF was disappeared completely.Although several complications ensuing,such as hydrocephalus,intracranial infeion and leakage of cerebrospinal fluid,the patient was discharged with the wounds well healed and no neurological deficits and visual loss on the 21st day after the operation.Conclusions As orbito - cranial penetrating injury frequently results cerebral vascular injury which may cause fatal intracranial hemorrhage,early assessment of the patient with cerebral angiography is strongly recommended.Secondly,in case foreign body penetrated into cavernous sinus region,CCF should be highly suspected and retained foreign body had better to be pulled out in support of neurological intervention.Finally,one should keep in mind that post - traumatic CCF due to orbito - cranial penetrating injury can be latent or show no typical symptoms,and extraction rashly of residual foreign body may lead to fatal bleeding. Key words: Carotid - cavernous fistula; Orbito - cranial penetrating injury; Endovascular embolization